Pharmacy Fee For Service Prior Authorization (PA) Contacts
Change Healthcare Pharmacy PA Unit
Toll-free: 877-537-0722
Fax: 877-537-0720
Registered Users in the Change Healthcare PA Portal
If you are a Mississippi Medicaid prescriber, submit your Fee For Service prior authorization requests through the Change Healthcare provider portal.
- Register or submit prior authorization requests through the Change Healthcare provider portal.
- MississippiCAN prior authorizations
Drug Prior Authorization Instructions
| Prior Authorization Packets | Updated |
|---|---|
| Brand Name Multi-Source | 6/21/2019 |
| Early Refill | 6/21/2019 |
| Enteral Nutrition | 6/21/2019 |
| EPSDT – Beneficiaries Under 21 | 6/28/2019 |
| Hepatitis C Therapy | 6/1/2021 |
| Max Unit Override | 6/21/2019 |
| Multiple Concurrent Antipsychotics for Beneficiaries (Age < 18) | 6/21/2019 |
| Opioid Packet – Effective 8/1/2019 FAQs | 9/10/2019 |
| PDL Exception Request | 6/21/2019 |
| RSV-SYNAGIS® (effective until March 5, 2021) | 9/30/2020 |
| Universal Prior Authorization Form | 6/21/2019 |
Manual Prior Authorization Criteria
